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Table 2 Learning Outcomes for pMSK medicine for medical students

From: What do they need to know: achieving consensus on paediatric musculoskeletal content for medical students

Generic Child Health Learning Outcomes

 Establishing interaction

  1. Establish rapport with child and family.

  2. Respect privacy and confidentiality for the child and family.

  3. Use appropriate behaviour and language in relation to the developmental stage of the child.

  4. Modify history taking and examination according to child’s developmental stage (e.g. questions about functional activities).

 History Taking

  5. Recognise symptoms such as persistent pain, night pain, fever and weight loss as red flag symptoms for malignancy or significant systemic disease.

  6. Elicit and document a pain history.

  7. Identify major milestones within development.

  8. Use a pain score or simple tools to assess level of pain.

 Examination

  9. Demonstrate an understanding of ways to engage children when examining to maintain co-operation and minimise discomfort.

  10. Demonstrate awareness of developmental staging.

  11. Demonstrate awareness that a neurological examination may be indicated (e.g. in the context of back pain) and the important associations such as paraesthesiae and loss of bladder/bowel function.

 Investigations

  12. Identify the role of blood tests such as FBC, ESR, CRP.

  13. Discuss the indications for plain X-ray.

  14. Demonstrate a systematic approach to interpretation of plain X-rays (e.g. of bony fracture).

  15. Discuss the purpose of other investigations such as CT (to look at bone), MRI (to look at soft tissue) or bone scan (to look for inflammatory disease such as bony metastases or osteomyelitis).

 Management

  16. Summarise key points in the history and examination to form an overall impression.

  17. Use appropriate medical terminology in discussion with professional colleagues including anatomical landmarks where appropriate (e.g. extensor, flexor surfaces, relation to bones, muscles or joints).

  18. Relate history and examination findings to core conditions.

  19. Formulate a provisional differential diagnosis for core presentations.

  20. Demonstrate a structured ‘surgical sieve’ approach to a differential diagnosis (e.g. timing, possible aetiology such as inflammatory, infective, malignancy).

  21. Communicate provisional proposed management plan verbally to child and family after discussion with their teachers.

  22. Demonstrate awareness of the importance of a multi-disciplinary team in managing a child with musculoskeletal disease.

  23. Outline the principles of managing children with chronic disease (e.g. considering impact on school, play and family, need for medications and monitoring, and the role of healthcare professionals).

  24. Plan and discuss a simple approach to the management of pain - use of a pain ladder, reassurance and simple analgesia

  25. Help medical staff in liaising with other healthcare providers regarding management plan e.g. nursing staff, primary care, physiotherapist.

pMSK specific learning outcomes

 History taking

  26. Record pattern of injury.

  27. Demonstrate awareness of injury patterns suggestive of Non-Accidental Injury.

  28. Recognise the importance of a full family and social history and their relevance to musculoskeletal presentations.

  29. Recognise the need for extended musculoskeletal history in certain presentations (e.g. limp, pain, rashes, refusing to walk).

  30. Include a brief musculoskeletal history in review of systems in all history taking encounters.

  31. Recognise features in the history that may distinguish mechanical from inflammatory musculoskeletal pathology.

 Examination

  32. Perform an examination that screens the musculoskeletal system (e.g. paediatric Gait, Arms, Legs, Spine) understanding that positive findings should lead to more detailed examination.

  33. Demonstrate the principles of regional musculoskeletal examination incorporating a look, feel, move approach.

  34. Demonstrate awareness that limitation of movement of joints could arise from pathology within the joint, muscle or bone.

  35. Recognise that skin and nail abnormalities may be associated with musculoskeletal disease (e.g. nail pitting, rashes).

  36. Identify clinical features that suggest an inflamed joint.

  37. Recognise clinical features suggestive of a septic joint and the place of appropriate investigations and referral.

  38. Recognise that normal children have increased joint flexibility compared to adults and may be hypermobile.

  39. Recognise that Marfan’s and Ehler’s Danlos syndromes may be associated with hypermobility.

  40. Observe and describe principles of gait patterns (e.g. symmetry, leg alignment, presence of pain, limp).

  41. Demonstrate awareness that leg alignment and foot posture changes with age and normal variants within these - knock knees, bow legs, flat feet, in-toeing.

  42. Elicit signs of muscle weakness and be aware of the possibility of proximal myopathy.

 Investigations

  43. Discuss results of FBC, ESR, CRP in context of musculoskeletal presentations and potential implications (e.g. raised white cell count and possible sepsis).

 Management

  44. Describe musculoskeletal presentations of malignancy such as nocturnal bone pain, swelling, systemic features such as weight loss.

  45. List specialist opinions that may be necessary for musculoskeletal conditions (e.g. orthopaedics, rheumatology, ophthalmology) and discuss when this may be relevant.